Articles: trauma.
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Eur J Trauma Emerg Surg · Feb 2024
The most critically injured polytrauma patient mortality: should it be a measurement of trauma system performance?
The risk of death after traumatic injury in developed trauma systems is at an all-time low. Among 'major trauma' patients (injury severity score, ISS > 15), the risk of dying is less than 10%. This group contains critical polytrauma patients (ISS 50-75), with high risks of death. We hypothesized that the reduction in trauma mortality was driven by reduction in moderate injury severity and that death from critical polytrauma remained persistently high. ⋯ The improvement in trauma mortality over the past 20 years has not been experienced equally. The ISS50-75 critical polytrauma mortality is a practical group to capture. It could be a group for deeper study and reporting to drive improvement.
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Fibrinogen and platelet, as the two main components of hemostatic resuscitation, are frequently administered in traumatic massive hemorrhage patients. It is reasonable to infer that they may have an impact on post-traumatic sepsis as more and more recognition of their roles in inflammation and immunity. This study aims to determine the association between the fibrinogen/platelet transfusion ratio during the first 24 h after trauma and the risk of the post- traumatic sepsis. ⋯ Early and sufficient supplementation of fibrinogen was a convenient way contribute to reduce the risk of sepsis after trauma.
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Observational Study
Have outcomes of trauma in centenarians changed in the last 15 years?
Centenarians are an often forgotten and under-reported group. Trauma in this population is a substantial cause of morbidity and mortality. 15 years ago, a small observational study examined the outcomes of trauma in centenarians in a single trauma unit, concluding that age alone should not be a determinant of treatment. Following implementation of national standards of care for trauma patients in older adults, this study re-examined outcomes in centenarians admitted secondary to trauma to assess if outcomes have changed. ⋯ Outcomes of centenarians admitted secondary to trauma have been maintained but not improved in the last 15 years in our centre. Following this we must consider if more must be done to improve outcomes in this underreported but growing patient demographic.
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Journal of neurosurgery · Feb 2024
The effect of patient age on the degree of midline shift caused by chronic subdural hematomas: a volumetric analysis.
Chronic subdural hematomas (CSDHs) are the among the most common conditions treated by neurosurgeons. Midline shift (MLS) is used as a radiological marker of CSDH severity and the potential need for urgent surgical evacuation. However, a patient's age may affect the degree of MLS for a given hematoma volume. This study aimed to investigate the correlation between the patient's age and the MLS caused by CSDH. ⋯ For a fixed CSDH volume, older age correlates with significantly lower MLS. This could be explained by higher parenchymal compliance in older individuals due to increased brain atrophy, and a larger subdural space. Clinical use of MLS to estimate severity of CSDH and gauge treatment decisions should take the patient's age into account.
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There have been several studies about the increasing accident risks and injuries of standing electric scooters, but there is no study about the dental traumatic injuries related with standing electric scooter so far. ⋯ The standing electric scooter-related dental trauma resulted in an increased prevalence of relatively severe dental trauma. Supplementation and reinforcement of the related policies as well as strict enforcement of the laws on electric scooter users will be needed to prevent severe dental and craniofacial trauma.